BEING LEAST INTRUSIVE April Struthers M.Ed, R.C.C. & Lindsay Neufeld, MSW RSW <ul><li>An orientation to practice in respon...
<ul><li>‘ Our Elders have for so many years had people push into their lives. We as health professionals think we have aut...
Introduction <ul><li>Emerged from 5 years of collaboration on the issue of Abuse and Neglect of older adults, across multi...
Introduction <ul><li>The development of working partnerships between Health Authorities (designated agencies) and FN healt...
Being Least Intrusive: the working paper <ul><li>Desire to articulate the foundational concepts underpinning a different o...
Being Least Intrusive: the working paper <ul><li>Informed by direct and comprehensive feedback, frontline experience, dial...
A coalescing of ideas, collaborative work, and intentional partnerships <ul><li>BCACRN was commissioned by FNIH and PHAC t...
Flowchart of Intervention  <ul><li>Outcome of BCACRN project commissioned by FNIH and PHAC:  Maps  where different tools a...
Key Question <ul><li>What is my role in facilitating a culturally safe encounter and experience? </li></ul>
9
10
Being Least Intrusive: the tool <ul><li>Developed to assist front line service providers (primarily non-aboriginal) in ori...
Being Least Intrusive: the tool <ul><li>Challenges clinicians to  </li></ul><ul><ul><ul><li>engage in  critical practice <...
Being Least Intrusive: Core Concepts <ul><li>Most Effective, Least Intrusive   </li></ul><ul><ul><ul><ul><li>BC Adult Guar...
14
Being Least Intrusive: the tool 15
Being Least Intrusive: the questions 16 <ul><li>Orientation to Self: </li></ul><ul><li>When:  prior to engagement </li></u...
Being Least Intrusive: the questions 17 <ul><li>Orientation to Self: </li></ul><ul><li>Will any of my values or biases imp...
Being Least Intrusive: the questions 18 <ul><li>Orientation to Context </li></ul><ul><li>Community and Culture </li></ul><...
Being Least Intrusive: the questions 19 <ul><li>Orientation to Context </li></ul><ul><li>Community and Culture </li></ul><...
Being Least Intrusive: the questions 20 <ul><li>Orientation to Context </li></ul><ul><li>Specific Situation </li></ul><ul>...
Being Least Intrusive: the questions 21 <ul><li>Orientation to Context: </li></ul><ul><li>Gathering Information </li></ul>...
Being Least Intrusive: the questions 22 <ul><li>Orientation to Context: </li></ul><ul><li>Assessment </li></ul><ul><li>Wha...
Being Least Intrusive: the questions 23 <ul><li>Orientation to Context: </li></ul><ul><li>Assessment </li></ul><ul><li>How...
Being Least Intrusive: the questions 24 <ul><li>Orientation to Reflection Process: </li></ul><ul><li>Was I least intrusive...
Being Least Intrusive: the questions 25 <ul><li>Orientation to Reflection Process: </li></ul><ul><li>What did I learn abou...
Thank You  <ul><li>An Invitation </li></ul><ul><ul><li>Feedback is welcomed   - it will shape our final tool version – bei...
Thank You  <ul><li>April Struthers  </li></ul><ul><ul><ul><li>Email:  witworks@dccnet.com  </li></ul></ul></ul><ul><ul><ul...
Reports Available <ul><li>Promising Approaches for Addressing / Preventing Abuse of Older Adults in First Nations Communit...
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Bli Bcasw Conference Nov 5 2010 (Update Nov3)

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Presentation of Being Least Intrusive to social workers

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  • We are goin g to look today at 3 things A paper A flowchart of intervention from another project A recently developed tool chosen to be developed and distributed nationally
  • The Association has been involved in 3 promising approaches projects commissioned by the Public Health Agebn cy of canada – littlke research, no stnadards of evidence based practice, few tools for FN, none culturally appropriate that we know of
  • Using term as entry point for FN (abuse a harsh word-avoids denial) Interpersonal engagement resulting in co-creation of meaning-has to be more culturally safe
  • Continual ‘conversations that matter’ as relationships have grown; extracting themes and issues; framing and reframing what we understand for feedback; listening carefully to expressions of issues and interests and needs; Asking what would help, offering our models for consideration in a very gentle way. Based on refelxive learning process-using aciton learning cycle
  • Finding showed there were virtually no tools to use with adult abuse situations. No tools available which were culturally appropriate and aimed at adult abuse. Further, people asked for a process to follow in intervening-this was generally not established in the communities we talked to ; if available outside communities -were not known within communities. Matched feedback from other source-VIHA work, Assoc work, BLI thinking Explain last point
  • Found processes and protocols/procedures are underdeveloped in communities we spoke to-looking for both; don’t re-invent the wheel. Most cases handled on case by case basis- hangover of emotional impact of these cases is extensive…can only go so far in intervening. Need to be able to explain larger picture- An additional piece to the BLI Tool; preceded it as process to guide use of tools generally. Tool fits within-people tell us they need both .
  • Here is a critical question that gets asked all the way along the ‘flow’ of this flowchart… Each person has a role, inside and outside of the community
  • Ovals are ‘start’ and ‘end’ points Diamonds are points of decision Boxes are roles or processes Raised bumps are where cultural safety is considered / darker bumps=more safety (I would say cultural safety needs to be considered throughout in different ways)
  • Practical application of the approach In the absence of other tools why not develop??
  • re·spect  (r -sp kt ) tr.v. re·spect·ed , re·spect·ing , re·spects 1. To feel or show deferential regard for; esteem. 2. To avoid violation of or interference with: respect the speed limit. 3. To relate or refer to; concern. n. 1. A feeling of appreciative, often deferential regard; esteem. See Synonyms at regard . 2. The state of being regarded with honor or esteem. 3. Willingness to show consideration or appreciation.
  • Cultural safety – poster by Ball in every SW office… Recommend Assembly of First Nations Wholistic Planning and Policy model, balance wheel cultural framework used to assess data form aborig sources by aborig researchers to interpret and substantiate aboriginal health indicators – status. Used questions reflecting fundamental questions as indentified by AFN for health determinants. Trying to avoid re-authoring aboriginal concepts or practices-interpret through other eyes in addition to ours
  • Last spring somebody asked ‘what would it take to turn this paper / approach into a tool for front line use in intervening?” A concrete tool to help frontline workers engage with clients, families and communities in a critical, reflexive and culturally safe way Based on concepts and questions indicated by AFN culutural framework- an aboriginal lens lens to look at aboriginal health data informed by quesitons about health determinants Based on all other concepts in paper. Paper underpinned an approach – tool is by contrast the intervention
  • Being least Intrusive Paper: available at www.bccrns.ca
  • Bli Bcasw Conference Nov 5 2010 (Update Nov3)

    1. 1. BEING LEAST INTRUSIVE April Struthers M.Ed, R.C.C. & Lindsay Neufeld, MSW RSW <ul><li>An orientation to practice in responding to situations of abuse and neglect of vulnerable First Nation adults </li></ul>
    2. 2. <ul><li>‘ Our Elders have for so many years had people push into their lives. We as health professionals think we have authority to do that. We need to remember it is a privilege and honor to be involved in Elders’ lives – we need to give honor and dignity.’ </li></ul><ul><li>‘ You can be accepted by Elders so you can do your job – make yourself present and you will know when they accept you.’ </li></ul><ul><li>Dorothy Hutchinson </li></ul><ul><li>Home and Community Care Director </li></ul><ul><li>Peter Valentine reserve </li></ul><ul><li>Grand Rapids, Manitoba </li></ul>1
    3. 3. Introduction <ul><li>Emerged from 5 years of collaboration on the issue of Abuse and Neglect of older adults, across multiple dimensions </li></ul><ul><ul><ul><li>Practice implications of BC Adult Guardianship legislation for FN individuals and communities </li></ul></ul></ul><ul><ul><ul><ul><li>What does it mean to be “least intrusive” </li></ul></ul></ul></ul><ul><ul><ul><ul><li>What is our role and responsibility in facilitating culturally safe encounters and environments </li></ul></ul></ul></ul><ul><ul><ul><li>The use of CRN model in developing collaborative response to abuse & neglect in FN communities </li></ul></ul></ul><ul><ul><ul><ul><li>Lots of interest in the model and approach </li></ul></ul></ul></ul>2
    4. 4. Introduction <ul><li>The development of working partnerships between Health Authorities (designated agencies) and FN health organizations in responding to situations of abuse & neglect of older adults in FN communities . </li></ul><ul><ul><ul><ul><li>Building mutual capacity to respond to situations of abuse and neglect in culturally relevant and safe ways </li></ul></ul></ul></ul><ul><li>Identification of ‘promising approaches’ utilized across Canada by service providers working in the area of abuse and neglect of adults </li></ul><ul><ul><ul><ul><li>Few tools identified used to specifically address abuse and neglect of vulnerable adults. No assessments reflecting aboriginal point of view </li></ul></ul></ul></ul>3
    5. 5. Being Least Intrusive: the working paper <ul><li>Desire to articulate the foundational concepts underpinning a different orientation to practice in responding to situations of abuse and neglect of vulnerable FN individuals. </li></ul><ul><ul><ul><li>Being least intrusive </li></ul></ul></ul><ul><ul><ul><li>Re-conceptualizing Vulnerability and Capability to reflect the social, cultural and historical context in which vulnerability, risk emerge </li></ul></ul></ul><ul><ul><ul><li>Cultural Safety: a critical outcome of encounters </li></ul></ul></ul><ul><ul><ul><li>Integrating Mainstream and Indigenous knowledge and practice theory to develop a more holistic epistemological approach </li></ul></ul></ul><ul><ul><ul><li>Collaborative, meaning centered approach </li></ul></ul></ul>4
    6. 6. Being Least Intrusive: the working paper <ul><li>Informed by direct and comprehensive feedback, frontline experience, dialogue and collaboration with FN partners and colleagues. </li></ul><ul><ul><ul><ul><li>KDC Health and HCC partnership in Campbell River </li></ul></ul></ul></ul><ul><ul><ul><ul><li>4 Provincial dialogues with 20 First Nations communities (PGT /BCACRNS /HA) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2 regional video conferences with ITHA / WHRN </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Introducing Re:ACT & FN Re:ACT materials to First Nations communities & health authority staff (VIHA) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>WEAAD events / BCACRN outreach </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Participation/Dialogue at First Nation Health Forums (KDC) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Direct review of BLI paper by clinicians, FN colleagues </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Issues raised at VIHA Aboriginal Health Council </li></ul></ul></ul></ul>5
    7. 7. A coalescing of ideas, collaborative work, and intentional partnerships <ul><li>BCACRN was commissioned by FNIH and PHAC to do a scan of national tools and promising approaches, specific to adult abuse and neglect. </li></ul><ul><li>The ideas behind “Being least Intrusive” and the findings of the ‘Promising Approaches” scan came together rather unexpectedly </li></ul><ul><ul><ul><ul><li>the ‘Flowchart of Intervention’ blended the findings, feedback and approach of both projects </li></ul></ul></ul></ul><ul><li>Public Guardian and Trustee of BC commissioned work to develop a provincial template for an interagency protocol between provincial health authority and First Nation communities specifically addressing the issue of adult abuse and neglect. </li></ul><ul><ul><ul><ul><li>It is being piloted and adapted to an existing partnership between VIHA and KDC Health (North Vancouver Island) </li></ul></ul></ul></ul>6
    8. 8. Flowchart of Intervention <ul><li>Outcome of BCACRN project commissioned by FNIH and PHAC: Maps where different tools and promising approaches could be used within an over process / flow of response </li></ul><ul><li>Outcome of Being Least Intrusive: Illustrates a front line response process internal to FN reserve communities ( non-designated agency) </li></ul><ul><li>Defines a coordinated and intentional process of response. </li></ul><ul><li>Encourages collaboration within communities as well when communities and ‘outside’ agencies partner to respond together. </li></ul><ul><li>Identifies community strengths, gaps in resources, </li></ul><ul><li>Builds Capacity to respond more effectively (case/community) </li></ul>7
    9. 9. Key Question <ul><li>What is my role in facilitating a culturally safe encounter and experience? </li></ul>
    10. 10. 9
    11. 11. 10
    12. 12. Being Least Intrusive: the tool <ul><li>Developed to assist front line service providers (primarily non-aboriginal) in orientating themselves to respond to situations of abuse and neglect of vulnerable FN adults in a way that : </li></ul><ul><ul><ul><li>Is Culturally Safe </li></ul></ul></ul><ul><ul><ul><li>Facilitates a more holistic understanding of health and wellness </li></ul></ul></ul><ul><ul><ul><li>Honors cultural and spiritual diversity </li></ul></ul></ul><ul><ul><ul><li>Creates Space for collaboration and partnership, and the development of deeper understanding </li></ul></ul></ul>11
    13. 13. Being Least Intrusive: the tool <ul><li>Challenges clinicians to </li></ul><ul><ul><ul><li>engage in critical practice </li></ul></ul></ul><ul><ul><ul><li>understand vulnerability, abuse and neglect in the social, historical and cultural context within which it emerged and is experienced </li></ul></ul></ul><ul><ul><ul><li>be reflexive and develop critical self-awareness of social location and power </li></ul></ul></ul><ul><ul><ul><li>be thoughtful, intentional, respectful in their engagement with clients, families and communities </li></ul></ul></ul>12
    14. 14. Being Least Intrusive: Core Concepts <ul><li>Most Effective, Least Intrusive </li></ul><ul><ul><ul><ul><li>BC Adult Guardianship Legislation </li></ul></ul></ul></ul><ul><li>Cultural Safety </li></ul><ul><ul><ul><ul><li>Jessica Ball, UVIC </li></ul></ul></ul></ul><ul><li>Vulnerability and Capability (re-conceptualized): </li></ul><ul><ul><ul><ul><li>Vanguard Project, BC A&N Collaborative </li></ul></ul></ul></ul><ul><li>Aboriginal Understanding of Health: </li></ul><ul><ul><ul><ul><li>Assembly of First Nations : Social Determinants of Health </li></ul></ul></ul></ul><ul><li>Meaning Centered Practice : </li></ul><ul><ul><ul><ul><li>Clark </li></ul></ul></ul></ul><ul><li>Social Work Theory : </li></ul><ul><ul><ul><ul><li>Anti-Oppressive Practice </li></ul></ul></ul></ul>13
    15. 15. 14
    16. 16. Being Least Intrusive: the tool 15
    17. 17. Being Least Intrusive: the questions 16 <ul><li>Orientation to Self: </li></ul><ul><li>When: prior to engagement </li></ul><ul><li>Who am I (personal and professional role, socio-economic status, cultural affiliations, worldview, etc)? </li></ul><ul><li>What is/are my understanding, attitude, assumptions about the issue of abuse, neglect and self-neglect of vulnerable adults? and of vulnerable First Nation adults? </li></ul>
    18. 18. Being Least Intrusive: the questions 17 <ul><li>Orientation to Self: </li></ul><ul><li>Will any of my values or biases impede my role/responsibility in creating a safe environment or safe encounter for the client/family with whom I am working? </li></ul><ul><li>Who am I in relationship to the client/family/community with whom I am working? (How do they see me? understand my role? What is the power differential?) </li></ul>
    19. 19. Being Least Intrusive: the questions 18 <ul><li>Orientation to Context </li></ul><ul><li>Community and Culture </li></ul><ul><li>When: before casework begins. </li></ul><ul><li>What are the resources within the community (eg. social & health care services, eldercare services)? </li></ul><ul><li>Are there specific protocols of engagement (eg. cultural traditions, values) with/within this community that I need to be aware of and incorporate? </li></ul>
    20. 20. Being Least Intrusive: the questions 19 <ul><li>Orientation to Context </li></ul><ul><li>Community and Culture </li></ul><ul><li>Who can I partner with in this community – who is the most appropriate person (has a knowledge of and connection to the client/family, is in a position of trust, can act as a cultural guide and can assist in developing a culturally safe and appropriate support and assistance plan)? </li></ul><ul><li>What is the history of engagement, collaboration that my organization (eg. community health agency) has had with this specific community regarding service delivery? </li></ul>
    21. 21. Being Least Intrusive: the questions 20 <ul><li>Orientation to Context </li></ul><ul><li>Specific Situation </li></ul><ul><li>When: prior to engaging with client/family/community </li></ul><ul><li>What are the objective details of this situation? (What are the facts, overarching or specific concerns reported, who is involved)? </li></ul><ul><li>Who reported the concerns of abuse & neglect (e.g. family, client, community member, service provider) and what is their connection to the situation? </li></ul><ul><li>Will my involvement with client/family/community be welcome? </li></ul>
    22. 22. Being Least Intrusive: the questions 21 <ul><li>Orientation to Context: </li></ul><ul><li>Gathering Information </li></ul><ul><li>When: over the course of multiple interactions with client/those involved </li></ul><ul><li>How does the client experience his/her own Physical, Mental, Emotional and Spiritual Health? </li></ul><ul><ul><li>What are the words they use to describe their current state of well-being and functioning across these dimensions? </li></ul></ul><ul><ul><li>How do they make sense of the current situation? </li></ul></ul><ul><ul><li>Do they have any specific concerns about any aspects of their health and well-being? </li></ul></ul><ul><ul><li>How do the client’s perspective, experience and meanings differ from those of their family, caregivers and service providers? </li></ul></ul>
    23. 23. Being Least Intrusive: the questions 22 <ul><li>Orientation to Context: </li></ul><ul><li>Assessment </li></ul><ul><li>What are the specific factors in the following holistic dimensions that contribute to the client’s vulnerability or act to protect against or mitigate client’s risk? </li></ul><ul><ul><li>Physical well-being (physical functioning, health issues, activity level) </li></ul></ul><ul><ul><li>Mental well-being (cognitive functioning, education, mental health) </li></ul></ul><ul><ul><li>Emotional well-being (self-esteem, sense of control over forces affecting one’s everyday life, livelihood and health) </li></ul></ul><ul><ul><li>Spiritual well-being (cultural identity, engagement, integration - past/present) </li></ul></ul><ul><ul><li>Relationships (connection and belonging to family, extended family, community, land, environment/creation) </li></ul></ul><ul><ul><li>Social Well-being (income, security of shelter and food, language, access to support and resources) </li></ul></ul>
    24. 24. Being Least Intrusive: the questions 23 <ul><li>Orientation to Context: </li></ul><ul><li>Assessment </li></ul><ul><li>How will I distinguish between my understanding/definition of health, well-being and risk from those of the client/family/community/culture with whom I work? </li></ul><ul><li>How will I distinguish between my values regarding standards of care, family relationships, physical surroundings and those of the client/family/community/culture with whom I work? </li></ul>
    25. 25. Being Least Intrusive: the questions 24 <ul><li>Orientation to Reflection Process: </li></ul><ul><li>Was I least intrusive/most effective in my intervention (e.g. was the client’s autonomy respected, was the client’s self-determination and right to live at risk balanced against the need for support and assistance)? </li></ul><ul><li>Was my involvement experienced by the client as culturally safe (was client’s cultural identity, values and preferences taken into account in the service encounter; was the client engaged in the encounter; was the client involved in developing a respectful and appropriate support and assistance plan, did the client welcome my involvement, was I invited back for further engagement)? </li></ul>
    26. 26. Being Least Intrusive: the questions 25 <ul><li>Orientation to Reflection Process: </li></ul><ul><li>What did I learn about myself (were my values and assumptions about the situation, client, culture, etc challenged?) </li></ul><ul><li>What is the feedback I have received from client, family, community, colleagues about the process? </li></ul><ul><li>How could my practice improve? </li></ul>
    27. 27. Thank You <ul><li>An Invitation </li></ul><ul><ul><li>Feedback is welcomed - it will shape our final tool version – being formed through action research; to be distributed nationally </li></ul></ul><ul><ul><ul><ul><li>Focus Groups </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fill in evaluation and feedback form </li></ul></ul></ul></ul><ul><ul><li>One of 9 tools being developed by NICE through the Federal Elder Abuse Initiative </li></ul></ul><ul><ul><li>Please visit us at the NICE table or contact one of us </li></ul></ul>26
    28. 28. Thank You <ul><li>April Struthers </li></ul><ul><ul><ul><li>Email: witworks@dccnet.com </li></ul></ul></ul><ul><ul><ul><li>Tel: 604 885 0651 </li></ul></ul></ul><ul><li>Lindsay Neufeld </li></ul><ul><ul><ul><li>Email: [email_address] </li></ul></ul></ul><ul><ul><ul><li>Tel: 250 850 2172 </li></ul></ul></ul>27
    29. 29. Reports Available <ul><li>Promising Approaches for Addressing / Preventing Abuse of Older Adults in First Nations Communities </li></ul><ul><li>Being Least Intrusive: An Orientation to Practice </li></ul><ul><li>www.bccrns.ca/projects/index.php </li></ul>
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